US$2 billion for health and humanitarian assistance: What is changing in the U.S. aid model?

Key reasons to read the article

• The U.S. is putting billions back into aid, but through a radically different system.
• Five-year funding sounds reassuring, until you read the small print.
• Faith-based organizations are moving to the center of U.S. aid. What could that mean for who receives financial assistance?
• Bilateral deals are replacing parts of the old aid architecture. Could that make assistance vulnerable to politics?
• US$2 billion is a major commitment, but how much of it will actually reach the people who need it?

After drastically restructuring its foreign assistance in early 2025 by winding down traditional operations managed by the U.S. Agency for International Development (USAID), Washington is back with US$2 billion to meet global health and humanitarian needs. But this is not based on the aid model the sector has been familiar with for decades. Faith-based organizations and bilateral agreements are assuming a more prominent role, raising questions about who will control the money, who could lose access to it, and whether this funding announcement is truly genuine.

The financial package promises to strengthen more than 2,500 faith-based hospitals, clinics and community hubs across 17 countries, and train, pay and equip over 30,000 community health workers. Yet the commitment comes with a crucial qualification: the funding is subject to availability.

So, what exactly is Washington building? A new, locally rooted aid delivery model, or a different way of channeling U.S. assistance, whose effectiveness and sustainability remain to be tested?

A new architecture for U.S. aid

The significance of this announcement lies not simply in the amount of money involved, but in how the U.S. intends to channel it. The US$2 billion package forms part of the America First Global Health Strategy (AFGHS), and combines funding for faith-based and community health providers with bilateral health agreements between governments, and humanitarian awards.

The Department of State explains that the package features three main strands:

• US$850 million will be allocated over five years through the Faith and Community Initiative to help faith-based hospitals, clinics, and community hubs.
• US$570 million in development assistance will be directed to faith-based hospitals and clinics through bilateral, government-to-government health agreements.
• US538 million will fund global humanitarian assistance awards to non-governmental organizations such as World Vision and Compassion International, with US100 million immediately available for humanitarian assistance in places where natural disasters have recently happened or are likely to happen.

This package could signal that, following the dismantling of USAID, the U.S. government is not closing the door on humanitarian assistance. But the question is, who will now deliver US-funded assistance? And what does the change mean for the organizations that previously held a central position within the U.S. aid architecture?

Who will deliver the aid?

Two features of the new architecture stand out. The first is the greater role faith-based and community organizations will play. The second is the decrease in international, multilateral cooperation and a greater emphasis on direct, government-to-government (G2G) agreements. Both could alter the long-lived balance between international organizations, governments and local providers.

Faith-based delivery

The original announcement named World Vision, Compassion International, and Samaritan’s Purse among the principal faith organizations involved in the new funding arrangement. Samaritan’s Purse subsequently declined the proposed US$300 million grant, stating it would continue to rely on private funding. The Department of State has not publicly specified how that funding will now be reallocated.

The U.S. administration argues that, rather than choices based on ideology or values, the decision to back faith-based organizations is based on their high levels of efficiency in delivering relief, ensuring that at least 80% of all resources are used in frontline services, compared with 35-40% in previous programs, while overhead costs and management spending both decrease.

However, the announcement does not offer evidence of this comparison and neither does it make it clear how the 80% target will be measured and monitored. In an interview with NPR, Jeremy Konyndyk, President of Refugees International and a former humanitarian official at USAID, argues that in the aftermath of the recent earthquakes in Venezuela, the U.S. government prioritized funding for Samaritan’s Purse, which slowed its relief efforts compared to other NGOs already operating locally.

Faith-based organizations receiving U.S. funding is not a new concept with World Vision, for example, having long implemented publicly funded health and humanitarian programs. Nonetheless, the significance of the current announcement is the prominent role explicitly given to faith-based organizations.

That makes it relevant to ask what safeguards will govern publicly funded assistance and whether access will remain based on need rather than religious affiliation. Consequently, will the principles of humanitarian aid still be governed by non-discrimination and impartiality?

Less multilateralism, more direct deals

The second method of delivery is likely to have a huge impact on the international landscape. The U.S. has chosen to place greater emphasis on bilateral, government-to-government partnerships with other countries as a way of delivering health assistance, thereby reducing the role of international forums such as the United Nations. Under USAID, funding almost never went directly to governments with much of it being implemented by NGOs and other third-party partners.

As G2G agreements are becoming a vehicle for U.S. health assistance, questions arise over whether they can deliver health assistance effectively while also protecting the independence and continuity of aid programs.

This is exemplified in the proposed US-Zambia deal under the AFGHS – which, at the time of writing, has yet to be signed – whereby US access to vital minerals in the country was reported to be a prerequisite for receiving support. These allegations have intensified concerns that health assistance could become entangled with wider U.S. strategic interests.

In a similar vein, human rights and data privacy concerns have been voiced around other African deals, with several countries such as Zimbabwe and Ghana withdrawing from or delaying negotiations. Human Rights Watch has also raised concerns about the limited public disclosure of the wording of the agreements.

These concerns highlight the risks in the design and implementation of the new bilateral health agreements that remain to be addressed. Paul Spiegel, Director of the Johns Hopkins Center for Humanitarian Health, told DevelopmentAid that such deals are usually created for stable countries, and work far less effectively for countries in crisis.

“In eastern DRC [the Democratic Republic of the Congo], for example, the government does not control all of its territory, and it is unclear whether funds provided under the US-DRC agreement will reach areas controlled by rebel groups. That is precisely where assistance must be impartial and independent, and where UN agencies, pooled funds and NGO networks still provide the coordination, scale and access that no bilateral deal can,” he explained.

Questions about commitment

The Center for Global Development, while supporting the humanitarian intent of bilateral agreements, echoes the possibility of pitfalls: “Governments can be keystones in achieving scalable, cost-effective public service delivery; U.S. foreign assistance should prioritize local, country-led goals and systems … but the mechanism matters.”

That mechanism comes down to three practical questions: “How will the agreements work?” “How long will the commitments last?” and “How much funding will actually be available?” The U.S. administration does provide many indications that could answer these questions, leaving important details of implementation unclear. What remains, therefore, is ambiguity.

The main part of the humanitarian assistance is expected to be for a period of five years, but with the aid “subject to the availability of funds”. This does not sound particularly secure. Much can happen between now and five years to alter the direction and availability of this aid package. Budgets, administrations, and foreign policy priorities can change, potentially affecting the pace or scale of implementation. As Spiegel comments, “bilateral compacts tie assistance to one donor’s annual politics. That is the opposite of sustainable.”

What will happen to the thousands of hospitals, clinics, and the workers who are to be trained under this new plan when the five year period comes to an end, or if the funding runs out before then, is unclear. Such uncertainty will make it difficult for organizations and partner countries to invest in agreements.

Spiegel argues that a five-year term is standard in U.S. aid agreements, but that does not mean it can be considered certain. “The words are not new. The trust behind them is what has changed. Since early 2025, partners have watched signed awards terminated overnight and appropriated money go unspent. Read against that record, a five-year pledge with that clause is a warning, not a guarantee,” he noted.

He added, “the intent is welcome. Multi-year, predictable funding is exactly what health actors have long asked for. Yet, independent analyses suggest several countries, Liberia, Malawi and South Sudan among them, have committed to more than their budgets can plausibly deliver. If Washington under-delivers and finance ministries cannot close the gap, the shortfall lands in clinics and on the people they are meant to serve.”

Is this worth the effort for humanitarian organizations and governments?

When asked if these agreements are the future of American humanitarian aid, Spiegel replied that there has been too little time to make a decisive evaluation: “No one can say yet.”

That comment would suggest neither immediate dismissal nor uncritical optimism. “My advice to governments, faith-based organizations and NGOs is to engage, but to plan for the possibility of the money not arriving: diversify donors, build genuine transition plans, invest in domestic financing and local capacity, and press for the full agreements and budgets to be published.”

Bottom line, any increase in funding for humanitarian assistance is needed and welcome, but questions remain about the faith-based exclusivity and the effectiveness of bilateral agreements as well as the availability and duration of the funding.

Speaking to NPR, former Chief Economist of USAID, Dean Karlan, echoed this double-edged sword: “I prefer to see the money spent than not spent, and I do think [it] will create some good … [but] is it the best we could have done? I doubt it because there’s no sign that they used evidence in any way to guide this decision.”

The central test seems to be not whether the new model is ideologically different from that which it replaces, but whether it can deliver assistance at the scale, speed and predictability that health systems and humanitarian organizations need. The US$2 billion package may help to close some of the gaps created by the restructuring of U.S. foreign assistance, but it is unlikely to address all of them on its own. Its longer-term significance will depend on whether the new architecture can translate the announced commitments into sustained, effective assistance on the ground.